title: Aromatase inhibitors affect vaginal proliferation and steroid hormone receptors.
abstract: OBJECTIVE
  Women with breast cancer who are treated with aromatase inhibitors often experience vaginal atrophy symptoms and sexual dysfunction. This work aims to study proliferation and the presence and distribution of steroid hormone receptors in vaginal biopsies in relation to vaginal atrophy and vaginal pH in women with breast cancer who are on adjuvant endocrine treatment and in healthy postmenopausal women.
  
  
  METHODS
  This is a cross-sectional study that compares postmenopausal aromatase inhibitor-treated women with breast cancer (n = 15) with tamoxifen-treated women with breast cancer (n = 16) and age-matched postmenopausal women without treatment (n = 19) or with vaginal estrogen therapy (n = 16). Immunohistochemistry was used to study proliferation and steroid hormone receptor staining intensity. Data was correlated with estrogen and androgen levels, vaginal atrophy scores, and vaginal pH.
  
  
  RESULTS
  Aromatase inhibitor-treated women had a lower grade of proliferation, weaker progesterone receptor staining, and stronger androgen receptor staining, which correlated with plasma estrone levels, vaginal atrophy scores, and vaginal pH.
  
  
  CONCLUSIONS
  Women with aromatase inhibitor-treated breast cancer exhibit reduced proliferation and altered steroid hormone receptor staining intensity in the vagina, which are related to clinical signs of vaginal atrophy. Although these effects are most probably attributable to estrogen suppression, a possible local inhibition of aromatase cannot be ruled out.
authors.affiliation: From the 1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; 2Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden; and The Schools of 3Health and Medical Sciences and 4Medicine, Örebro University, Örebro, Sweden.
authors.forename: Theodora Kunovac
authors.initials: TK
authors.lastname: Kallak
authors.forename: Juliane
authors.initials: J
authors.lastname: Baumgart
authors.forename: Emma
authors.initials: E
authors.lastname: Göransson
authors.forename: Kerstin
authors.initials: K
authors.lastname: Nilsson
authors.forename: Inger Sundström
authors.initials: IS
authors.lastname: Poromaa
authors.forename: Anneli
authors.initials: A
authors.lastname: Stavreus-Evers
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001284:Atrophy; D001706:Biopsy; D001943:Breast Neoplasms / Q000188:drug therapy*; D049109:Cell Proliferation / Q000187:drug effects; D017024:Chemotherapy, Adjuvant; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D017698:Postmenopause; D011944:Receptors, Androgen / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D011987:Receptors, Steroid / Q000032:analysis*; D013629:Tamoxifen / Q000627:therapeutic use; D014621:Vagina / Q000737:chemistry* / Q000187:drug effects / Q000473:pathology*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D011944:Receptors, Androgen; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D011987:Receptors, Steroid; D013629:Tamoxifen